2002年至2007年成都市儿童医院新生儿常见病原菌分布及耐药趋势

目的 探讨成都市儿童医院新生儿感染性疾病病原菌分布及耐药趋势变化规律. 方法从成都市儿童医院2002年至2007年住院的感染性疾病新生儿痰液、血液、脑脊液、尿液、脓/分泌物、胸腹腔积液、局部穿刺液等标本中分离病原菌1050株,进行细菌培养、药敏试验及耐药表型检测分析,并进行前3年(2002年至2004年)与近3年(2005年至2007年)的比较. 结果 2002年至2007年新生儿常见病原菌中革兰阴性(G-)菌713株(67.9%),革兰阳性(G+)菌337株(30.8%),酵母样菌14株(1.3%).前3年与近3年相比,G-菌和G+菌比例的总体趋势相似,新生儿病原菌排序发生变化(χ2=18.654,P=0.009);常见病原菌耐药趋势呈多态性变化,耐甲氧西林金黄色葡萄球菌检出率分别为10.0%和18.4%(U=1.090,P>0.05),耐甲氧西林凝固酶阴性的葡萄球菌菌株检出率分别为4.9%和53.1%(U=2.169,P<0.05),大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶菌株合计检出率分别为25.0%和60.6%(U=5.281,P<0.01),流感嗜血杆菌产β-内酰胺酶率分别为1/6和40.3%(U=1.144,P>0.05). 结论成都市儿童医院新生儿感染病原菌流行分布及耐药趋势与国内其他地区比较存在着差异,近3年与前3年相比常见病原菌排序发生变化,病原菌常见耐药表型检出率明显增加,耐药性呈多态性变化.动态监测新生儿感染病原菌分布及耐药趋势变化对指导临床合理使用抗菌药物、防止新生儿抗菌药物滥用以及减少患者耐药菌株终身携带十分必要.

Analysis of epidemic distribution and drug resistance of clinically-isolated bacteria in neonates of Chengdn Children's Hospital from 2002 to 2007

Objective To investigate the epidemic distribution and variation of drug resistance of common pathogenic bacteria in neonates of Chengdu Children's Hospital. Methods All the bacteria isolated from 2002 to 2007 were analyzed. Tests were performed according to the guidelines of National Committee for Clinical Laboratory Standards. Results Gram negative (G-) bacteria accounted for 67.9%, Gram positive (G+) bacteria and fungi accounted for 30.8% and 1.3% respectively of the 1050 strains isolated. Although the mutative tendency of proportion between G-and G+ bacteria was similar, the sequence of common pathogenic bacteria in neonates was different (χ2=18.654, P=0.009) between the former (2002 to 2004) and later three years(2005 to 2007). The trend of antibiotics resistance of the pathogenic bacteria changed and common phenotype of drug resistance also altered from the former to later three years. The proportion of methicillin-resistant Staphylococcus aureus was 10.0% and 18.4% (U = 1.090, P>0.05); the methicillin-resistant coagulase-negative Staphylococci rate was 4.9% and 53.10% (U= 2.169 ,P<0.05) respectively in the former and later three years. The total proportion of extended spetrum β-lactamase strains in Escherichia coli and Klebsiella peumoniae were 25.0% and 60. 6 % (U= 5.281, P<0.01); the rates of β-lactamase production strains of Hemophilus influenzae were 1/6 and 40.3% (U= 1.144, P>0.05). Conclusions The distribution of common pathogenic bacteria in neonates of Chengdu Children's Hospital had changed and the trend of drug resistance of pathogenic bacteria was eteriorated in recent three years. Monitoring the regional changes in pathogenic bacteria and the trend of drug resistance is important for clinical treatment of neonatal infections.